Retinopathy and Blood Thunder Overview

Retinopathy

• Retinopathy is damage to the retina, the light-sensitive tissue at the back of the eye.
• Retinopathy can cause vision loss and blindness if untreated.
• Common causes of retinopathy include hypertension, increased blood viscosity, diabetes, and chronic obstructive pulmonary disease (COPD).
• Symptoms of retinopathy can include blurred vision, floaters, flashing lights, and a loss of central vision.
• A cherry red spot on the macula indicates a retinal occlusion.
• If an occlusion lasts longer than an hour, it can lead to optic nerve atrophy.
• Treatment for retinopathy depends on the severity of the condition and may include laser surgery or medications.

Blood Thunder

• Blood Thunder refers to a sudden and dramatic increase in blood pressure, often accompanied by a headache, dizziness, and nausea.
• It is a rare but serious condition that can lead to a stroke or other serious complications if not treated.
• Blood Thunder is often associated with preeclampsia, a dangerous condition that can develop during pregnancy.

Central Retinal Vein Occlusion (CRVO)

• CRVO causes gradual vision loss.
• CRVO is more common than acute vision loss.
• Caused by a blockage of the central retinal vein, which carries blood away from the retina.
• Symptoms include blurred vision, floaters, and a loss of central vision.
• There is a pale optic disc with cupping.

Cataracts

• Cataracts are a clouding of the natural lens of the eye.
• Cataracts are a common age-related condition.
• Cataracts can also be caused by diabetes, smoking, and exposure to ultraviolet radiation.
• Symptoms of cataracts include blurred vision, halos around lights, and difficulty seeing at night.
• Treatment for cataracts involves surgery to remove the clouded lens and replace it with an artificial lens.

Chronic Glaucoma (Open Angle)

• Characterized by a gradual increase in intraocular pressure (IOP), which damages the optic nerve.
• Damage to the optic nerve can lead to peripheral vision loss.
• Over time, glaucoma can progress and cause blindness.
• Often no symptoms until advanced stages, leading to undetected damage.
• Risk factors include age, family history, and diabetes.
• Treatment includes medications to lower IOP, laser surgery to increase drainage, and surgical procedures to improve drainage.

Diabetic Retinopathy

• Diabetic Retinopathy results from damage to the blood vessels in the retina caused by diabetes.
• Early stages do not produce symptoms.
• Advanced stages cause vision loss or blindness.
• It is the leading cause of preventable blindness in adults with diabetes.
• Nonproliferative Diabetic Retinopathy - stage 1
  • Decreased circulation with endothelial damage
  • Retinal ischemia occurs
  • Microaneurysms develop and rupture - creates superficial flame hemorrhages and deeper blot hemorrhages
  • Soft exudates (caused by leakage of proteinaceous material) and hard exudates (fatty deposits on the retina)
  • Cotton wool spots (caused by nerve fiber ischemia)
• Proliferative Diabetic Retinopathy - stage 2
  • Same findings as stage 1, but more severe
  • Neovascularization (growth of new blood vessels) near the optic disc
  • New vessels bleed easily and can lead to a retinal detachment

Hypertensive Retinopathy

• Hypertensive Retinopathy results from damage to the blood vessels in the retina caused by high blood pressure.
• Copper-silver wiring of the arterial wall on the retina due to engorged blood vessels
• Arteriovenous (A/V) nicking due to thickened arterial walls
• Flame hemorrhages and soft exudates
• Optic disc edema (indistinct disc margins)
• Optic disc can be several times larger - can also happen with a brain tumor (papilledema) due to increased IOP

Macular Degeneration (Senile)

• Macular Degeneration primarily affects central vision, making it difficult to read, drive, or recognize faces.
• Usually affects both eyes.
• Characterized by a pigmented macula, exudates, and drusen appearance.
• Treatment options include laser surgery and medications.

Types of Hearing Loss

• Conductive Hearing Loss - originates from the outer or middle ear, causing sound to not reach the inner ear properly.
• Sensorineural Hearing Loss - originates from the inner ear or the auditory nerve, causing damage to the sensory receptors or nerve pathways.

Weber Test

• Assesses bone conduction.
• A tuning fork is held on the top of the head to determine if sound is louder in one ear than the other.
• Conductive hearing loss: sound lateralizes to the affected ear (bc no air conduction, only bone).
• Sensorineural hearing loss: sound lateralizes to the unaffected ear (bc the good nerve is intact).

Rinne Test

• Compares air conduction (AC) and bone conduction (BC).
• A tuning fork is placed on the mastoid bone (BC) and then moved to the ear canal (AC).
• Normal: AC > BC
• Conductive Hearing Loss: BC > AC
• Sensorineural Hearing Loss: AC > BC

Etiologies of Hearing Loss

• Presbycusis: Age-related, common cause of sensorineural hearing loss.
• Noise Exposure: Prolonged exposure to loud noises can damage the delicate inner ear.

Vestibular Neuronitis

• Definition: Inflammation of the vestibular division of the eighth cranial nerve (CN VIII), usually viral.
• Incidence: Common, usually affects people between 30-40 years old.
• Symptoms: Abrupt onset of debilitating vertigo, usually unidirectional horizontal nystagmus.
• First Attack: Usually most severe and typically recurrent.
• Nystagmus:
  • Peripheral: Latency, fatiguing, unidirectional, ameliorated by gaze fixation.
  • Central: No latency, no fatigue, multidirectional, exacerbated by gaze fixation.

Vestibular Migraine

• Definition: Migraine headaches with a sudden onset of dizziness or vertigo.
• Symptoms: Vertigo, headache, nausea, vomiting, sensitivity to light and sound, visual disturbances.
• Diagnosis: Based on clinical presentation, history, and neurological examination.

Otitis Media (OM)

• Definition: Inflammation of the middle ear characterized by ear pain, fever, and hearing loss.
• Risk Factors: Daycare attendance, exposure to smoke, family history of recurrent OM.
• Ear Findings: Red tympanic membrane (TM), decreased light reflex, thickened TM, bulging of TM, drainage
• Causes: Bacterial infections (Strep pneumoniae, H. influenza, Moraxella catarrhalis)
• Treatment: Amoxicillin is the antibiotic of choice for initial and uncomplicated OM.
• Signs of Severity: infants < 6 months, toxic appearing (severe pain, fever, decreased feeding).